Drug utilization of clarithromycin for gastrointestinal disease treatment.
OBJECTIVE
To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.


METHODS
Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release (IR) or sustained-release (SR) product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively.


RESULTS
One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori (H pylori) therapy, triple therapy take the dominant position (91.8%), followed by quadruple therapy (4.3%) and dual therapy (3.9%). Amoxicillin was the most frequently co-prescribed antibiotic. Furazolidone and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating H pylori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription (0.9%) of clarithromycin IR was prescribed for unapproved indication (i.e. gastro-oesophageal reflux disease). 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified.


CONCLUSIONS
There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration schedule, concordance between indications and diagnoses and management of drug interactions.
Zhou
Quan
Q
Department of Clinical Pharmacy, Zhejiang University, Zhejiang Province 310009, China. zhouquan142602@zju.edu.cn
Zhu
Ling-Ling
LL
Yan
Xiao-Feng
XF
Pan
Wen-Sheng
WS
Zeng
Su
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002681:China; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D054869:Clinical Audit; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D016481:Helicobacter Infections / Q000188:drug therapy; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D019518:Postprandial Period; D011500:Protein Synthesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents; D011500:Protein Synthesis Inhibitors; D017291:Clarithromycin